Malnutrition Remains Major Killer in Nepal

Number of children with acute malnutrition remains near emergency levels despite decades of effort and millions of aid dollars.

Breastfeeding within the first hour after birth and exclusive breastfeeding for the first six months can strengthen a child’s immune system for years. But only around half of babies are breastfed within the first hour -51 percent in urban areas and 44 percent in rural areas, according to the 2011 DHS. Fortunately, exclusive breastfeeding rates are improving - now 70 percent, up from 53 percent in 2006.

Still, mothers of malnourished children lack proper healthcare before and after birth. “Most of the time, they are expected to get back to household chores like working in the farm and the kitchen just a few days after delivery, and it affects the mother’s health and nutrition,” he added.

While 88 percent of urban mothers received antenatal care from a skilled provider, only 55 percent of rural mothers did so, according to the DHS. Additionally, some 23 percent of mothers nationwide gave birth before age 18.

Poor agriculture investments

A key challenge in fighting acute malnutrition is simultaneously addressing its many causes, said WFP’s Oberlin.

“Some of these factors weigh more heavily in certain geographic areas, or within certain social categories. For instance, food insecurity in remote areas is a serious contributing factor, where unavailability and lack of access to food, combined with poverty, have a dramatic impact on nutrition,” he added.

A quarter of the population lives under the national poverty line, and nearly 3.5 million people have difficulty getting nutritious foods, according to WFP.

“A lot of investment is needed now in the agricultural sector, but, unfortunately, the investment and funding by both the government and aid agencies have reduced a lot,” said Pitamber Acharya, director of Development Project Service Centre, a local NGO working on agriculture and food security.

According to the Ministry of Agriculture and Development, donor support to agriculture declined from 2002-2006. Overall government spending has more than doubled since 2006, but spending on agriculture has remained unchanged.

Poor priority-setting

Water as doubled-edged sword in fight against malnutrition. PHOTO: Marcus Benigno/IRIN Until now, the central government has relegated malnutrition issues to a four-person nutrition unit, led by DOH’s Pokharel. The unit ranks low within health ministry’s hierarchy.

“The way that the nutrition section has not been given prominence shows the government’s negligence over the past years, and the small team is actually doing [its] best to reduce malnutrition. But that is really a herculean task for them to cover the whole nation,” said Paneru from the Nepal Youth Foundation.

Still emerging from a decade-long civil conflict that killed an estimated 18,000 civilians, the country has been without local government since 1997, leaving nearly 4,000 “village development committees” with only one person, appointed by the national government, to keep basic services going.

A new constitution that would lead to local elections has yet to be approved. Promised in 2010, draft approval has been delayed four times, most recently on 27 May.

Ongoing political squabbling also delayed the new fiscal budget by eight months, which held up money needed for development, said Chandan Sapkota, an economist at the South Asia Watch on Trade, Economics and Environment office in the capital, Kathmandu.

Change?

But agencies and the health workers are still hopeful. The government launched its first inter-ministerial national nutrition plan on 20 September. Donors have pledged close to 60 percent of the plan’s US$150 million 2014-2017 budget, while the government has set aside near $12 million for 2012-2013 nutrition interventions.

The National Planning Commission will monitor spending for the new nutrition plan, which is expected to create a national centre for nutrition and a “food security secretariat”.

DOH’s nutrition team anticipates this will translate into improved nutrition and has proposed hiring 35 staff for the national centre, nutrition supervisors for all of the country’s 75 districts, and nutrition officers for each of the five regional health offices.

“We have, however, yet to see how things will shape up,” said Pokharel, referring to the ongoing political deadlock.

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